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Gout – the pain in your a…toe


Needle-like crystals in your joints and connective tissue does not sound like fun. It isn’t. Gout is one of the oldest recorded diseases in medical history, dating back to the invention of the big toe. That is where the pain usually starts before migrating up the leg to other joints or connective tissue.  It is common in sites like the elbow and ear where it will manifest as pain, swelling or hard deposits.  It is caused by irregularities in purine metabolism. Purines are nitrogen containing organic compounds that make up certain proteins in the body and are metabolised into uric acid. Gout is the result of excess uric acid forming those needle-like crystals I mentioned earlier. It is an inflammatory arthritis that can be both chronic and acute.

visceral fatGout usually presents in males over the age of 35 although in older populations the distribution between males and females evens out a little. A common co-morbidity of gout is obesity. Visceral fat stores increase the risk of insulin resistance (diabetes) and atherosclerosis (hardening of the arteries) in overweight sufferers of gout. While weight loss does offer a protective measure against gout, the ketosis associated with very low carbohydrate diets appears to act as a trigger for acute attacks of gout. Other triggers include surgery, lead exposure, excessive eating or drinking and heavy exercise. People with high blood pressure, kidney disease and users of diuretic medication are also at risk. Due to an association with dyslipidemia (abnormal cholesterol), diabetes and insulin resistance it is worth screening for these concerns if you struggle with gout.

Treatment is primarily in the form of medical therapy to reduce purine and uric acid formation. Nutrition guidelines are prudent although two thirds of the purines we produce are from bodily processes and only the remaining third is contributed by our diet. Still this one third is something we can manage by following these guidelines:

  • Protective foods include low fat dairy and Vitamin C containing foods 
  • Total protein intake does not appear to affect purine production but a high amount of meat and seafood does
  • Choose alternative protein sources such as chicken, turkey, eggs or dairy
  • Alcohol should be consumed in moderation. Limit your intake of beer
  • Moderate levels of wine may be protective
  • Choose wholegrains. Refined carbohydrates and added sugars should be avoided
  • A dietary distribution of 40% carbohydrates, 30% fat and 30% protein seems suitable
  • Consult with a dietician to achieve this through a balanced meal plan.

During acute attacks it is advisable to drink plenty of water (3 litres per day) and avoid high purine foods such as:

  • Anchovies, herring, mackerel, sardines, fish roe, mussels
  • Liver, kidneys and hearts
  • Gravy
  • Meat extracts (Bovril etc.)
  • Yeast supplements

A popular complementary approach to treating gout is the Alkaline Ash Diet. This is based on including foods that can increase the pH (making it more alkaline) of urine and may assist the symptoms of gout. Personally I think this is rubbish and I would recommend focusing on the guidelines above instead .

This is a worthwhile page providing a short summary for anyone who ever brings up the acid and alkaline debate.

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